Comment
Planetary health: a new science for exceptional action
“We have lived our lives by the assumption that what was
good for us would be good for the world. We have been
wrong. We must change our lives so that it will be possible
to live by the contrary assumption, what is good for the
world will be good for us. And that requires that we make
the effort to know the world and learn what is good for it.”
Wendell Berry, From The Long-Legged House (1969)
What is planetary health? In the final report of The
Rockefeller Foundation–Lancet Commission on Planetary
Health, we define it this way: “the achievement of the
highest attainable standard of health, wellbeing, and
equity worldwide through judicious attention to the
human systems—political, economic, and social—that
shape the future of humanity and the Earth’s natural
systems that define the safe environmental limits within
which humanity can flourish. Put simply, planetary
health is the health of human civilisation and the state of
the natural systems on which it depends”.1
Why might the idea of planetary health be useful?
There are two dimensions that planetary health seeks to
bring to human health. First, it situates human health
within human systems. The threats that our species faces
are not abstract physical risks, such as disease, climate
change, ocean acidification, or chemical pollution. The
risks we face lie within ourselves and the societies we
have created. When we consider climate change, the
main metric of danger is greenhouse gas emissions.
But that measure should also include the capacity of
human systems to monitor the threat, understand
its importance, and act on that knowledge. Second,
planetary health concerns the natural systems within
which our species exists—for example, the health and
diversity of the biosphere. Human beings live within
a safe operating space of planetary existence. If the
boundaries of that space are breached, the conditions
for our survival will be diminished. Currently, natural
systems are being degraded to an extent unprecedented
in history, with known and as yet unknown and
unquantified effects on human health. For example,
although evidence for causality between environmental
change through deforestation and Ebola virus disease
outbreaks is inconclusive, loss of forest land has
brought people and wildlife into closer contact—with
the inherent risks of zoonotic disease. There is surely an
intergenerational responsibility to do no further harm
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and to create the systems to allow future generations to Published Online
thrive and prosper—mentally, physically, and materially. July 16, 2015
http://dx.doi.org/10.1016/
We have previously tried to set out the minimum S0140-6736(15)61038-8
conditions for planetary health.2–4 As Stephen Boyden This online publication has
been corrected. The corrected
wrote in his book, The Biology of Civilisation, “While the version first appeared at
main threats to humankind today are the consequence thelancet.com on July 21, 2015
See Comment pages e36, e37,
of the human aptitude for culture, our only hope for and e39
overcoming them lies in this aptitude”.5 Human cultures See The Lancet Commissions
contain both the threat and opportunity for human page 1973
flourishing. Civilisations come and civilisations go,
typically over 300–500 year cycles.6 One should not be
surprised by this time-bound civilisational history. Our
museums are replete with artifacts from once great and
dominant human cultures. Why should our civilisation
be any different from the Assyrians, Mesopotamians,
or Mayans? But, as Karl Butzer notes in his survey of the
science of civilisations, “Much of the current alarmist
literature that claims to draw from historical experience
is poorly focused, simplistic, and unhelpful...Undue
attention to stressors risks underestimating the intricate
interplay of environmental, political, and sociocultural
resilience in limiting the damages of collapse or in
facilitating reconstruction”. Butzer prefers to focus instead
on the importance of “leaders, elites, and ideology”. In
other words, governance and stewardship. Here is where
human history meets current human predicaments.
What is abundantly clear today is that the dangers facing
our species will demand “urgent collective action at both
local and global levels”.7 Cooperation will be indispensable
Barcroft/Contributor/Getty Images
1921
 Comment
for our survival. But every day we see the limits of
our ability to collaborate with one another—conflict,
nationalism, competition. One active area of research that
is not obviously mainstream for global health, but which
is core to the idea of planetary health, is understanding
what helps or hinders human cooperation. Is it binding
democratic voting?8 Or “mutual coercion, mutually
agreed upon”?9 Or universal education?10 Or independent
accountability? The recent Lancet Commission on Health
and Climate Change will use an accountability mechanism
over the next 15 years to track, support, and communicate
progress and success in addressing the connections
between health and climate.11
The Rockefeller Foundation–Lancet Commission on
Planetary Health first met in Bellagio, Italy, in July, 2014.
Chaired by Andy Haines of the London School of Hygiene
& Tropical Medicine, the Commission is a diverse group
of global experts in environmental health, medicine,
biodiversity, and ecology who reached a powerful
consensus around key messages and the urgency of
planetary health as an idea in jeopardy. The Commission’s
report1 outlines three challenges that must be addressed
to enhance human health in the face of unprecedented
environmental challenges. First, a conceptual challenge
to account for the future health and environmental
harms to development and prosperity that many
countries face. Second, knowledge and information
challenges, including lack of transdisciplinary research
and a failure to identify the social and environmental
drivers of ill health. Finally, governance challenges.
Planetary health is a new science that is only beginning
to draw the coordinates of its interests and concerns. It
demands new coalitions and partnerships across many
different disciplines to meet the pervasive knowledge
failures identified by this Commission. It demands new
Alcohol burden in low-income and middle-income countries
Published Online Alcohol use contributes to roughly 4% of the global
September 17, 2015
http://dx.doi.org/10.1016/
burden of disease.1 Episodic (binge) drinking and high
S0140-6736(15)00236-6 average volume consumed both contribute to this
See Articles page 1945 burden in complex ways.1 Episodic drinking increases
risks of injury and cardiovascular disease; cancer risk
increases with average volume; and low–moderate
alcohol use is associated with a reduced risk of death
from cardiovascular diseases.2,3 A major limitation of the
1922
attention to governance and implementation. And,
perhaps most of all, it demands more creative imagination
among scientists and practitioners working in health—
redefining the meaning of human progress, rethinking
the possibilities for human cooperation, and revitalising
the prospects for the health of human civilisations.
Richard Horton, Selina Lo
The Lancet, London EC2Y 5AS, UK (RH); and The Lancet, Beijing,
China (SL)
We thank The Rockefeller Foundation for their generous financial support to
The Rockefeller Foundation–Lancet Commission on Planetary Health and for
hosting meetings in Bellagio, Italy, and New York, USA. We thank Andy Haines
for his chairing of the Commission and Sarah Whitmee for her lead
authorship. We thank Tim Shorten for project management of the
Commission and Micheline Kennedy of GMMB for leading communications
around global launches. We thank Commissioners for their commitment to
this Commission report and its dissemination, and peer reviewers for their
thoughtful contributions to the process. We also thank the participants of The
Rockefeller–Economist Visionaries Unbound Planetary Health workshop for
providing Commissioners with a broad background discussion to focus the
first Commissioners meeting.
1 Whitmee S, Haines A, Beyrer C, et al. Safeguarding human health in the
Anthropocene epoch: report of The Rockefeller Foundation–Lancet
Commission on planetary health. Lancet 2015; published online July 16.
http://dx.doi.org/10.1016/S0140-6736(15)60901-1.
2 Horton R. Offline: Planetary health—a new vision for the post-2015 era.
Lancet 2013; 382: 1012.
3 Horton R, Beaglehole R, Bonita R, Raeburn J, McKee M, Wall S. From public
to planetary health: a manifesto. Lancet 2014; 383: 847.
4 Horton R. Offline: Progress towards planetary health. Lancet 2015; 385: 314.
5 Boyden S. The biology of civilisation. Sydney: University of New South
Wales Press, 2004.
6 Butzer K. Collapse, environment, and society. Proc Natl Acad Sci USA 2012;
109: 3632–39.
7 Dasgupta P, Ehrlich PR. Pervasive externalities at the population,
consumption, and environment nexus. Science 2013; 340: 324–28.
8 Hauser OP, Rand DG, Peysakhovich A, Nowak MA. Cooperating with the
future. Nature 2014; 511: 220–23.
9 Levin SA. Public goods in relation to competition, cooperation, and spite.
Proc Natl Acad Sci USA 2014; 111 (suppl 3): 10838–45.
10 Lutz W, Muttarak R, Striessnig E. Universal education is key to enhanced
climate adaption. Science 2014; 346: 1061–62.
11 Watts N, Adger WN, Agnolucci P, et al. Health and climate change: policy
responses to protect public health. Lancet 2015; published online June 23.
http://dx.doi.org/10.1016/S0140-6736(15)60854-62.
evidence is that most epidemiological studies of alcohol
have been done in high-income and middle-income
countries. Good epidemiological data for patterns of
alcohol use and health outcomes among adults do not
exist in low-income and middle-income countries, in
which alcohol use is increasing as a result of growing
affluence and increased promotional activities of the
alcohol beverage industry.
www.thelancet.com Vol 386 November 14, 2015